CCS Foundation

Full Name (First, MI, Last)*:

Name while attending CCS:

Address*:

City*:

State*:

Zip*:

Phone Number:

( )  -

Birthdate (MM/DD/YY)*:

E-Mail Address*:

Date graduated or last attended*:

Program/Major*:

Degree(s) earned (i.e. Certificate, AAS, AA):

Please select the campus you attended*:

Select Campus Spokane Community College Spokane Falls Community College Both SFCC and SCC Institute for Extended Learning-Spokane IEL-Colville IEL-Inchelium IEL-Newport IEL-Republic IEL-Whitman County Extension IEL-Other

Employer:

Occupation:

If you played a sport for CCS, which sport did you play:

Spouse's Full Name:

Birthdate (MM/DD/YY):

Spouse's Email:

Did he/she attend CCS:

Select Yes/No Yes No

If so, what year did he/she last attend:

Which campus did he/she attend:

Select Campus Spokane Community College Spokane Falls Community College Both SFCC and SCC Institute for Extended Learning-Spokane IEL-Colville IEL-Inchelium IEL-Newport IEL-Republic IEL-Whitman County Extension IEL-Other Unknown

Program/Major:

Degree(s) earned (i.e. Certificate, AAS, AA):

Comments/Other Information: